


Diastole

by 8sword



Series: Fireworks [2]
Category: Supernatural
Genre: Bottom Dean, Doctor!Castiel, Domestic Castiel/Dean Winchester, M/M, Medical Jargon, The Great Escapist, nurse practitioner!Dean, really unforgivable and inappropriate use of the health field
Language: English
Status: Completed
Published: 2014-06-19
Updated: 2014-06-19
Packaged: 2018-02-05 06:29:59
Rating: Mature
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 1,727
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/1808728
Author URL: https://archiveofourown.org/users/8sword/pseuds/8sword
Summary: <blockquote class="userstuff">
              <p>Cas's recertification exam is coming up. Dean is making it very difficult to study.</p>
<p>(Another sort of timestamp to The Great Escapist.)</p>
            </blockquote>





	Diastole

**Author's Note:**

> This one happens probably a few years before "Fireworks." It makes no sense chronologically for Cas to be up for his boards again so soon, so please ignore that fact. I apologize for the inaccuracy, and also for the sheer existence of this fic. I'm going to the medical version of Tartarus, probably.
> 
> There are some medical definitions in the end notes if you need/want them.

 

"Dude." Dean flops over the side of their couch, his feet landing on Cas's lap and the review book open there. He looks at the red marks all over the practice test Cas did. "You are the _worst_ at heart murmurs."

Cas glares at him. "I don't see why we have to know what they sound like if we can just image them with an echo."

"Maybe because you didn't spend all that money on a fancy stethoscope just so you could wear it to look cool?"

"No," Cas says with dignity, "I use it to listen to breath sounds."

"Listen to this," Dean says, and farts.

"I will kill you."

Dean laughs hysterically and slides back off the couch, padding out of the living room. Cas shouts after him, "Don't leave me with your onion fumes, Dean Winchester!" and there's more laughter from the front hall.

His partner re-enters the room a moment later. His stethoscope is looped around his neck, and as Cas levels a baleful look at him, he grins. "Gimme an alcohol wipe."

Cas sighs long-sufferingly but reaches into the drawer of the side table next to him. It probably says a lot about them that they have boxes of alcohol pads in the drawers of all their side tables, but Dean insists on it, even though Cas rarely uses his own stethoscope on patients.

Dean tears one open and wipes his stethoscope down, stuffing the wrapper in the pocket of his worn-soft jeans. Then he jumps onto the couch and hunkers back onto his socked heels in the cushion, facing Cas. He pulls his t-shirt off and chucks it onto the armchair, then turns back to Cas, holding out his stethoscope. "Here."

Cas looks back and forth between Dean's chest, with the indentation of his sternal notch and the rose-brown nipples already starting to pebble in the cool air, and his Littman. "What?"

"Listen to me." Dean places the stethoscope's diaphragm over his second intercostal space and nudges Cas's hand with the earpieces. "C'mon."

Cas heaves another sigh but sets down his book and scoots forward, tucking his bare feet more fully beneath him. He fits Dean's stethoscope into his ears and puts his fingers around Dean's on the diaphragm. Dean doesn't move his own away, just presses the diaphragm a little more firmly against his chest. He's leaning forward, elbows on his knees, and immediately Cas can hear the sound of his heart, the steady _lub-dup_.

"You have to feel my pulse, too."

Cas glances up from beneath his eyelashes. Dean's barely holding back a smirk, looking down at him. Cas rolls his eyes but presses the pads of his index and middle finger against Dean's wrist. His pulse is nestled there against the strong tendons, and Cas closes his eyes to feel it better. Surrounded by the sensation and the sound of Dean's heartbeat steady in his ears. Feels his own blood starting to follow it.

He pulls out the earpieces.

"What?"

"We're not doing this," Cas says. "We are not making the medical things kinks anymore, Dean, it's weird and inappropriate."

"Uh, kinks and weird-slash-inappropriate kind of go together, in case you haven't noticed?"

Cas glares at him. It feels like he can still feel Dean's heartbeat thudding against his fingers.

"Besides," Dean says, "we're _learning_. Good, clean PBS fun over here." He grabs Cas's hand with the diaphragm and drags it back to his chest with a grin that Cas is pretty sure only _seems_ innocent, and Cas suffers the earpieces to be put gently back into his ears. He sighs.

"Systolic," Dean says, and Cas takes one earpiece out to be able to hear him. "The S's. S for systolic, S for the superior valves, S for stenosis. So it's the aortic and pulmonic valves that make systolic murmurs when they're stenosed."

"Aortic stenosis is a crescendo-decrescendo murmur," Cas recites in a murmur. "Heard best when the patient leans forward." He flattens his palm against Dean's sternum. The skin is warmer by now, against his cool palm; he curls his fingers against it. "Better heard with the diaphragm of the stethoscope because it's higher-pitched." He pulls the earpieces out for a moment. "It radiates to the carotids, you know. You can order echoes to distinguish it from carotid stenosis."

"No kidding?" Dean says patiently. "What'll happen if I squat?"

"More flatulence, probably."

Dean flicks him.

"Squatting decreases preload, so less blood is pushing through the stenosed area, and the murmur gets louder because there's less to push the obstruction open. You'll have a narrow pulse pressure--" Cas eyes the narrow space separating him from Dean, "and slow delayed pulse-- _parvus et tardus_."

Dean shifts on the balls of his feet and leans more heavily on Cas, bracing his elbow on Cas's thigh. "Careful, Novak-Shirley, you know it makes me all tingly when you talk in italics."

Cas Bitchfaces at him. Dean snickers and digs the point of his elbow into the meaty part of Cas's bent knee. "Pulmonic stenosis."

Cas's Bitchface gives way to a wrinkled forehead. After a moment, he says, "It sounds much the same as AS, only it increases with inspiration."

Dean grins up at him. Sometime during Cas's thinking he managed to get his head tucked under Cas's, his cheekbone digging into Cas's clavicle. Nothing makes Dean as cuddly as knowing more medicine than Cas. "Mitral regurg."

"It's a plateau holosytolic murmur," Cas says. He moves the diaphragm without being prompted, sliding it across Dean's pec down to his fourth rib space, and then up, against the grain of the fine hairs on his chest, to just outside his armpit, where he can feel Dean's blood throbbing. Maybe he likes teaching sessions with Dean, too; maybe it reminds him of when he was young and stupid and Dean was a beautiful boy in sneakers and scrubs. "Radiating to the axilla and heard best at the mitral area."

"And if I did this?" Dean closes his hand around Cas's wrist and squeezes.  

"Hand grip increases afterload," Cas says. "Opening the obstruction further and increasing the murmur of the insufficiency."

Dean lets go, though his thumb brushes over Cas's own banging pulse. "What a good student you are."

"Dean," he growls, half-hearted.

Dean just grins and resettles himself, draping himself across Cas's lap, now, in a semi-left lateral decubitus position. "Mitral valve prolapse."

Cas settles the diaphragm more firmly against Dean's mitral area, just under the curve of his pectoral muscle, the force just enough to be warning. Which is, of course, just enough to make Dean grin wider. "A click heard in the middle of systole."

Dean clicks his tongue. Cas resists the urge to lean down and suck on it. He rests his fingertips against the curve of Dean's jaw, instead, and Dean pushes his tongue against them through his cheek, eyes gleaming and sly on Cas's.

Cas lets out a breath that's almost a groan. Dean stops pushing his tongue against his fingers and turns his face into Cas's hand instead, and says against his palm, "Mitral stenosis."

Cas sits up. He very deliberately unloops the stethoscope from his neck and sets it on the coffee table, leaning over Dean stretched across his lap to do so. Then he enunciates in a growl, right into Dean's ear, "A low. Pitched. Rumble."

Dean shudders.

Cas smirks against his skin. "I could make an S4 joke here," he murmurs, grazing his teeth against Dean's earlobe. He drags his hand down from Dean's mitral area to his abdomen, and lower, down the curve of his abdominal muscles. "About…stiffness."

Dean bucks into his hand. "I dare you," he pants.

"No…" Cas's fingers dance lower. "I think I'm more interested in an S3."

Dean's laugh is taut. "What, you gonna make my heart go out?"

Cas's only reply is another smirk against the side of Dean's neck. And more teeth.

" _Shit_ ," escapes Dean through clenched teeth. Presses Cas's hand closer with one hand and hauls him in by a handful of t-shirt with the other until their mouths meet, press, slide. Pant.

Without pulling away from Dean's mouth Cas reaches over both their heads for the table drawer. Slaps around until he finds the handle, then scrabbles around inside it until he finds the other individual packets, the ones next to the alcohol swabs.

Dean laughs into his mouth when he hears the tell-tale tear of the wrapper.

Then his laugh turns into a very different sound.

 

"I'm going to fail," Cas says a while later. He's staring at the ceiling.

"You're not going to fail," Dean mumbles sleepily.

"I am. Thirty-five percent of the exam is cardiology. I'll be spending thirty-five percent of the test adjusting my pants and trying not to come."

Dean grins smugly into his arm. "You're welcome."

"You suck."

"Nope, that was you."

"Your puns also suck."

"You love them," Dean declares, and rolls over. His shoulder blade digs into Cas's collar bone. "How much of the test is proctology?"

"Dean," Cas warns, but Dean's already rolling back over and digging around on the floor for Cas's review book and the test breakdown on the inside cover. Cas grabs for him to haul him back onto the couch before he can grab it, but Dean knees him in the groin. Cas crumples, cursing, and they both tip head-first onto the floor.

"Uggghhhhh,"  Dean groans. "Naked rug burn."

Cas, whose front took the brunt of his own rug burn, is in too much pain to concur. He lies there with his eyes shut for a minute, until something is dropped on top of his face.

He opens his eyes. It's the review book.

Dean climbs on top of him again. "Fifteen percent proctology and urology. I'd say you're guaranteed to pass at least  fifteen percent of the test."

Cas's hands come up to hold Dean's hips as he starts to grind against him. "With flying colors, right?"

Dean's back arches. He closes his eyes as Cas rolls them over and settles between his legs, then opens them to grin up at him. "Are you kidding? Baby, you get the whole fucking pride flag."

Cas bursts into laughter.

 

("Hey, Cas," Dean says even later. "I bet it's not a coincidence that _pass_ has _ass_ in it."

Cas shoves a pillow into his face.)

 

 

 

 

 

 

 

**Author's Note:**

> Echo: short for echocardiogram, which uses sound waves to look at the heart and make sure the valves are working properly
> 
> Murmurs: sounds made by the heart valves when they are leaking or narrowed
> 
> Breath sounds: sounds made by air travelling through the passageways in the lungs
> 
> Littman: a brand of stethoscope
> 
> Diaphragm: the flat part of the stethoscope that is placed against the body to listen
> 
> S4: the sound made by a stiffened wall in the heart
> 
> S3: a sound made when the heart is suffering from too much blood volume, or overload, as is seen in heart failure 
> 
> proctology and urology: the study of a certain anatomical areas, hem-hem


End file.
